Low Coverage, Moderate Knowledge, And Limited Trust: An Assessment of Knowledge, Attitudes, And Perceptions Towards Indoor Residual Spraying in Masala, Ndola, Zambia

Background: Indoor Residual Spraying (IRS) is a proven vector control intervention for malaria prevention, yet community acceptance remains suboptimal in many settings. This study assessed the knowledge, attitudes, and perceptions towards IRS among residents of Masala Township in Ndola, Copperbelt Province, Zambia. Methods: A community-based cross-sectional study was conducted among 282 systematically selected adult residents of Masala Township using a structured questionnaire administered through face-to-face interviews (response rate: 89.5%). Knowledge scores (range 0-6) were categorized as poor, moderate, or good. Attitudes were measured using Likert scale items (range 1-5) and categorized as positive, neutral, or negative. Data were analysed using descriptive statistics, chi-square tests, and binary logistic regression (p<0.05). Results: IRS coverage in the last 12 months was low at 24.8% (70/282). Knowledge levels were moderate in 43.6%, with only 24.8% demonstrating good knowledge. Attitudes were neutral overall (mean score 3.2), with 29.8% positive, 43.6% neutral, and 26.6% negative. Perceptions of chemical safety were poor, with only 39.7% believing IRS chemicals are safe. Fear of side effects (46.2%) and limited of trust in the spraying process (31.6%) were the most commonly reported barriers to acceptance. Associated factors with positive attitudes included: past spraying experience (AOR=4.56, p<0.001), tertiary education (AOR=3.45, p=0.002), higher income (AOR=2.89, p=0.007), plastered walls (AOR=2.12, p=0.029), and better knowledge (AOR=1.42, p=0.003). Conclusion: IRS coverage in Masala (24.8%) is substantially below the WHO-recommended 80% threshold. Fear of side effects and lack of trust were the main barriers to acceptance. Factors associated with positive attitudes included education, income, knowledge, wall type, past spraying experience, and trust in health workers. Given the cross-sectional design, these findings represent associations, not causal relationships. Urgent interventions addressing safety concerns through enhanced community sensitization and trust-building are needed to improve IRS uptake and progress towards Zambia's malaria elimination goals.